Emergency medical services in the Lishan marathon

Objective: To describe the patient characteristics at a marathon at high altitude in Taiwan, and to provide data for planning future events. Materials and Methods: Medical care was provided for 600 runners, about 400 workers and more than ten thousand spectators at the 1999 Lishan Marathon (altitude 1,700 m to 2,600 m), coordinated by the Emergency Department of Veterans General Hospital-Taipei. There were four emergency physicians and eight emergency nurses. A standardized form was used to collect information including patient data, patient identification, time and place of the problems, types and causes of injuries, time and problems related to patient visit, positive physical findings, diagnosis, treatment and disposition. Results: During the marathon (from 04:30 am to 10:30 am), eighteen patients sought medical assistance at medical stations or in the field. Of these, sixteen were males and two were females. Their ages ranged from 15 to 73 with an average of 43 years. Of the 18 patients, 13 were runners (72%), including 8 mini-marathon runners (15 km) and 5 standard marathon runners (42.195 km), 3 were staff members and 2 were spectators. The medical use rates for the 600 runners, mini-marathon runners and standard-marathon runners were 2.17%, 2.00% and 2.50%. The most common problem was heat cramps (5 cases, 38.5%), followed by 4 cases of muscle strain and/or sprain (30.8%), 2 cases of abrasion and/or laceration (15.3%), one case of dehydration and one case of arrhythmia (multiform ventricular premature complex). The majority of patients had either minor ailments (6 cases, 46.15%) or moderate illness (7 cases, 53.85%). All patients left after being treated in the station. No patients were transferred by ambulance to the hospital. The medical use rate was similar to that of the 1997 Taipei Marathon. Since the number of runners was low, advanced studies are needed to draw firm conclusions. Conclusion: Although there were no cases of high mountain disease, and the majority of cases were minor or moderate, we found that special medical services were still needed for some patients. Therefore, a high quality, well-designed EMS system is important for mass gatherings at high altitude.